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What is the challenge your project is going to address and how does it connect to your chosen theme?

Challenges

1. Delay:  patients with AI experience multiple delays from initial detection:

  • Waiting for endocrine referral
  • Waiting for referral for endocrine investigations and/or repeat imaging
  • Waiting for results
  • Waiting for repeat testing in borderline cases (>20% cases)
  • Waiting for MDT slot
  • Waiting for clinic appointment (first patient contact)

2. Patient exclusion: patients undergo repeated testing with no clear insight until seen in clinic

3. Patient anxiety: besides the initial shock of unexpected scan findings, the delay and ongoing exclusion accentuate and prolong their distress.

4. Unnecessary outpatient visits: Frequently, outpatient capacity is used for discussion of normal or borderline results, reducing efficiency.

Theme connection

By use of remote (telephone) consultation:

  1. Delay: Time to first contact significantly shortened
  2. Patient exclusion: Patients involved and informed from the outset
  3. Patient anxiety: Early engagement reduces distress
  4. Unnecessary outpatient visits: Avoided

What does your project aim to achieve?

Objectives:

  1. To engage and inform patients from the outset
  2. To reduce patient distress
  3. To reduce face-to-face outpatient visits

Deliverables:

  1. To replace current face-to-face outpatient visits with a patient-focused telephone consultation service for new referrals and follow-up of borderline results.

Measures:

  1. Time from referral to first interactive patient contact.
  2. Engagement/satisfaction levels (compared with current system).
  3. Patient anxiety scores (including modified Hospital Anxiety and Depression Score [HADS]).
  4. Number of face-to-face outpatient visits saved.
  5. Cost-effectiveness (using our AI2CAT tool developed during previous HF i4i project).

How will the project be delivered?

Relevant people/skills

Out team:

  • Adrenal MDT team (including endocrinology, radiology, clinical biochemistry, urology): key clinical skills across the pathway from identification, management and investigations. Successfully secured funding for, and delivered, AI quality improvement projects (including two previous HF grants).
  • AI Patients: Insight into impact of AI, questionnaire design. Already contributed to focus group discussion
  • GP: Already part of the team, with insight on commissioning implications
  • Qualitative researcher: questionnaire design, facilitation of focus groups and data analysis
  • Statistician: qualitative data analysis
  • Coding input
  • Health economist: Already created AI2CAT cost-effectiveness tool
  • Outpatient lead

Risk management

Clear escalation strategy for abnormal/unexpected results, including emergency clinic slots.

Partners/Stakeholders

  1. Keele University: statistics
  2. Staffordshire University: qualitative
  3. UEA: Health economics
  4. AHSN: adoption
  5. Q Community: Team includes 2 members

What and how is your project going to share learning throughout?

Learning

  • Patient insight on telephone clinics as first interactive contact for new cases. Currently, telephone  clinics are only utilised to reduce follow-up slots. Our approach will explore their potential for new patients. This will be evaluated using cost-effectiveness, coding, outpatient efficiency, impact on patient journey (delay), in addition to balancing measures (eg impact of service level agreements)
  • Impact of intervention on reducing levels of distress and anxiety, whilst improving patient engagement/satisfaction.

Sharing

  • Q community/Q events: to learn (during the project) and share (after the project). We already utilise the Q Community RCT process to share ideas.
  • West Midlands AHSN ‘Meridian’ platform (as used previously for our HF-funded AI project).
  • Peer group sharing: National/international peer-reviewed publications/conferences.
  • Patient Board: We will establish an adrenal patient group to facilitate peer support and partner in the service innovation/delivery process.

How you can contribute

  • Assistance with refining existing patient engagement/satisfaction tools for our patient group.
  • Any previous experience with use of telephone clinics for new patients.
  • Insight/feedback on impact of telephone consultations on commissioning/contracts (balancing measures).

Plan timeline

26 Jun 2019
1 Feb 2020 Patient Board established & inital focus groups completed
31 Mar 2020 Patient Board update to refine tools
31 Mar 2020 Patient engagement/satisfaction & anxiety tools developed
1 Jun 2020 Data collection start
1 Jun 2020 Telephone clinic established
30 Sep 2020 Data collection completed
31 Dec 2020 Data analysis completed/dissemination plan created

Comments

  1. Hi both,

    i hope your plans are going well. I saw that you are looking for ideas about telephone clinics and tariffs. I supported a great renal team in Bristol who led a Telehealth clinics. They opted for offering this to existing patients not new ones as the feedback from patients was that phone calls were easier after they had made a therapeutic relationship with their consultants and nursing team. They also successfully negotiated a proof of concept tariff with the CCG by involving them early on. This took time to negotiate especially as blood tests had to be undertaken in primary care to enable this to work. I’d happily link you to the lead consultant if that was helpful for you?

    Good luck

    best wishes

    Anna

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